reducing unlabelled arterial blood gas results dr kelvin yau ct2 medicine (respiratory) wexham park...
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Reducing unlabelled Arterial Blood Gas results
Dr Kelvin YauCT2 Medicine (Respiratory)
Wexham Park Hospital
Wexham Park Hospital
Project Aim(s)Project Aim(s)• Increasing number of ABG results which are not labelled with oxygen
flow rate/air.
• This makes it difficult for clinician to interpret a patient’s acid base status
• The aim of this project is to reduce the percentage of ABG results are not labelled with oxygen/air.
• Secondary aim is to ensure ABG results are written in patient’s notes as the printouts fade with time
Wexham Park Hospital
Action PlanningAction PlanningWhat are we trying toaccomplish?
I am trying to reduce the percentage of ABG results which are not labelled with oxygen flow rate within 3 month period
How will we know that achange is an improvement?
By a reduction in the number of ABG which are not labelled with oxygen flow rate
What changes can we makethat will result inimprovement?
Placing a reminder next to ABG machine in A&E and Ward 9 (Respiratory) to remind users to label their ABG results with oxygen flow rate and write the result in the notes
Wexham Park Hospital
Process mappingProcess mapping
Wexham Park Hospital
ABG result needs to be labelled with oxygen flow rate/air and written in the notes
• Plan
• ABG results printouts are stuck into patient’s medical notes without information on whether the patient was on air or oxygen.
• Difficult to interpret the acid base status of the patient on admission. • ABG result printouts are loosely stuck in the notes with tendency to fall out and fade with
time. • 2 ABG machines in the hospital, One in A&E and one in Ward 9 respiratory. • • Do
• I looked at 50 ABG results in AMU and recorded the number of unlabelled ABG and number of results written in the notes and where the ABG was done.
•
PDSAPDSA
Wexham Park Hospital
• Study • The initial sample of 50 ABG showed 37 samples from A&E, 13 from Ward 9:• 38% (19/50) ABG results were not labelled• 37.8% (14/37) of the results from A&E machine were unlabelled• 38.5% (5/13) of the results from Ward 9 machine were unlabelled
• In terms of writing in the notes 22% (11/50) were written• 18.9% (7/37) A&E results were written • 30.8% (4/13) results from Ward 9 were written in the notes. • • Act• Large number of ABG results which are not labelled or written in the notes. • The next stage is to implement change to reduce the percentage of unlabelled ABG results
and increase the percentage of results written in the notes.
PDSAPDSA
Wexham Park Hospital
• Plan • Place a reminder next to the ABG machines in A&E and Ward 9 to remind users to label
their results with O2 flow rate and write their ABG results in the notes• • Do• Discussed with Outreach diagnostics who services ABG machine in order to request
permission to stick a reminder on the ABG machine. They are agree for me to put a reminder near the machines but not on it as it affects cleaning of the machine.
• • Designed a reminder and stuck it on the table next to the machines. I have laminated it in
order for it to be easily cleaned if spillage happened. • • Discussed with the doctors in A&E and they are aware of my QIP•
PDSA (2)PDSA (2)
Wexham Park Hospital
• Study• • There is a small increase in percentage of unlabelled ABG results
• No improvement in the number of results written in the notes.
• This maybe because it is too early for any change to be detected. • • Act• • Continue to measure weekly in order to detect any improvement. If there is no
improvement then review the situation and plan the next cycle
PDSA (2)PDSA (2)
Wexham Park Hospital
• Plan• After 5 weeks of testing there was a small reduction in the number of unlabelled ABG
results but no improvement in the number of ABG results written in patient’s notes. • Most of the deficit originated from A&E. Decided to review the situation by discussing with
A&E staff.• • Do• Noticed that the reminder was covered up by folders next to the A&E machine. I also
found that some A&E doctors do not have barcode access to the ABG machine so they ask the nurses to run the test but the nurses did not label the results.
• • I repositioned the reminder and discussed with A&E staff about importance of labelling
ABG with oxygen flow rate.•
PDSA (3)PDSA (3)
Wexham Park Hospital
• Study • • This raises the issue that doctors should have their own barcodes in order to use the blood
gas machine and not borrow another person’s barcode. This is in accordance with hospital policy from Outreach diagnostics.
• • Due to time constraints in A&E it seems difficult to get medical staff to write the results in. • • Act• • To inform Outreach diagnostics that each user must have their own barcode. To continue
measuring the primary outcomes
PDSA (3)PDSA (3)
Wexham Park Hospital
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Wexham Park Hospital
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Wexham Park Hospital
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Wexham Park Hospital
What difference has beenWhat difference has beenmade?made?
• Reduced the number of unlabelled ABG results by about 10%
• Increased awareness in A&E of the importance of labelling ABG results
• Did not make a difference in increasing the number of results written in notes
Wexham Park Hospital
Learning pointsLearning points• ABG results should be labelled with oxygen flow rate/air and written in the
notes
• Identified a fundamental problem which affects patient care
• Approach this project with input from different departments
• Regularly reviewing the implemented change through the PDSA cycles
• Perhaps a reminder is not enough to encourage users to label their result printouts.
• It is difficult to encourage in A&E doctors to write the results in the notes, due to time constraints
Wexham Park Hospital
Next stepNext step
• Increase sample size by including other medical wards and surgical wards
• Further testing cycles and widespread education regarding the importance of labelling ABG results with flow rates and writing them in the notes
• Liaise with Outreach diagnostics to see if the software within the ABG machine can be changed so that an oxygen flow rate must be entered before result is printed out
Wexham Park Hospital
Team MembersTeam Members
• Supervisor – Dr Jayne Norcliffe
• Dr Kelvin Yau (CT2 Medicine)
Wexham Park Hospital